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Scientific letter
Bacteremia due to Desulfovibrio porci. Novel anaerobic pathogen associated with infectious enterocolitis
Bacteriemia por Desulfovibrio porci. Nuevo patógeno anaerobio asociado a enterocolitis infecciosa
José María Saavedra Martína,b,
Corresponding author
josesaavedra309@gmail.com

Corresponding author.
, María José Medina Pascuala,b, Sylvia Valdezate Ramosa,b, Francisco Franco Álvarez de Lunaa,b
a Servicio de Microbiología Clínica, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
b Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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including piperacilin&#47;tazobactam&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleItalic">Desulfovibrio porci &#40;D&#46; porci&#41;</span> is a new species recently described &#40;<a href="https://lpsn.dsmz.de/species/desulfovibrio-porci">https&#58;&#47;&#47;lpsn&#46;dsmz&#46;de&#47;species&#47;desulfovibrio-porci</a>&#41; in the gastrointestinal tract of pigs&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with no reported cases of infections in humans&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present two cases of bacteraemia due to <span class="elsevierStyleItalic">D&#46; porci</span> in patients with enterocolitis and sepsis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Case 1&#46; 65-year-old woman with a liver transplant treated with mycophenolate and tacrolimus&#44; who came to Accident and Emergency in August 2023 after 2&#8211;3 days of diarrhoea without blood or mucus&#44; and vomiting&#44; with a history of liver transplant in December 2014&#46; Examination revealed that she had no fever&#44; but she was dehydrated and had tachypnoea&#46; Her abdomen was soft and depressible&#44; but at the same time she had crampy abdominal pain and oligoanuria&#44; with no evidence of peritonism&#44; metabolic acidosis&#44; or acute kidney injury&#46; On CT there were clear signs of enterocolitis&#46; Fluid therapy and antibiotic therapy with piperacilin&#47;tazobactam were started in Accident and Emergency&#46; The patient developed septic shock of abdominal origin&#44; being admitted to the ICU with a poor response&#44; with multiple organ failure&#44; leading to her death less than 24&#8239;h after her admission to hospital&#46; Her condition was diagnosed as septic shock due to infectious enterocolitis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 2&#46; A 64-year-old man&#44; with no relevant history&#44; who attended Accident and Emergency in January 2022&#44; due to abdominal pain and diarrhoea without blood or mucus of five days&#8217; duration&#44; an episode of self-limited rectal bleeding&#44; and acute kidney injury&#46; He did not report fever&#46; On examination&#44; diffuse abdominal pain was observed&#44; without active bleeding on rectal examination&#44; dehydration&#44; tachypnoea&#44; distended abdomen without peritonism&#44; anuria and metabolic acidosis&#46; On CT there were clear signs of enterocolitis&#46; The patient developed septic shock of abdominal origin&#46; He responded poorly to treatment with piperacilin&#47;tazobactam&#44; with refractory hypotension&#44; anuria&#44; haemodynamic and cardiac failure&#44; and died in less than 24&#8239;h&#44; despite antibiotic treatment under emergency observation&#44; due to refractory septic shock and enterocolitis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In both cases&#44; in blood cultures obtained in Accident and Emergency &#40;BACTEC FX system&#44; Becton&#8211;Dickinson&#44; two sets consisting of an aerobic bottle&#44; BACTEC Plus Aerobic&#47;F and one anaerobic&#44; BACTEC Lytic&#47;10 Anaerobic&#47;F&#41; growth was detected in an anaerobic flask on day 5 of incubation&#44; with curved gram-negative bacilli being observed in the Gram stain&#44; with little affinity for the counterstain&#46; They were subcultured on Columbia blood agar and chocolate agar plates &#40;ThermoFisher&#41; at 35&#8239;&#176;<span class="elsevierStyleSmallCaps">C</span> in an aerobic atmosphere with 5&#37; of CO<span class="elsevierStyleInf">2</span> and Schaedler plates &#40;ThermoFisher&#41; at 35&#176; in an anaerobic atmosphere &#40;GENbox anaer&#44; bioM&#233;rieux&#41;&#44; with growth on the anaerobiosis plates of very small punctate&#44; transparent&#44; smooth-edged&#44; non-haemolytic colonies after 72&#8239;h of incubation&#46; Identification with mass spectrometry &#40;MALDI-TOF&#44; Bruker&#41; did not provide any results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In both cases&#44; a microbiological study of the faeces was performed&#44; in one bacteriological culture and in the other molecular detection by multiplex PCR &#40;QIAstat-Dx Gastrointestinal Panel 2&#44; Qiagen&#41;&#44; with no pathogens detected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For taxonomic assignment&#44; the strain was sent to the Laboratorio de Referencia e Investigaci&#243;n en Taxonom&#237;a &#91;Reference and Research Laboratory in Taxonomy&#93; Centro Nacional de Microbiolog&#237;a &#91;National Microbiology Centre&#93;&#44; Instituto de Salud Carlos III &#91;Carlos III Health Institute&#93;&#46; The identification of the strains was carried out by analysis of the <span class="elsevierStyleItalic">16S rRNA</span> gene sequence using E781 and U1115 as primers and the Applied Biosystems 3730xl DNA Analyzer&#46; For strain CNM20220034 &#40;case 1&#41;&#44; a 1304&#8239;bp sequence was obtained which&#44; when compared to the sequences of the type strains deposited in the GeneBank database &#40;<a href="https://blast.ncbi.nlm.nih.gov/Blast.cgi">https&#58;&#47;&#47;blast&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;Blast&#46;cgi</a>&#41;&#44; had an percent identity of 99&#46;2&#37; with the type strain of <span class="elsevierStyleItalic">D&#46; porci</span> &#40;PG-178-WT-4&#41;&#46; For strain CNM20231004 &#40;case 2&#41;&#44; a 1409&#8239;bp sequence was obtained with a percent identity of 99&#46;2&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The alignment of the sequences of CNM20220034&#44; CNM20231004 and the type strain of <span class="elsevierStyleItalic">D&#46; porci</span> using Clustal W &#40;DNAStar Lasergene 15&#41;&#44; shows a percent identity of 100&#37; between the two strains&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The antibiogram was performed using the epsilometric method &#40;E-Test&#44; bioM&#233;rieux&#41; on <span class="elsevierStyleItalic">Brucella</span> agar with H &#38; K only in the first case&#44; detecting resistance to penicillin &#40;MIC&#8239;&#62;&#8239;32&#8239;mg&#47;l&#41;&#44; amoxicillin&#47;clavulanic acid &#40;MIC&#8239;&#62;&#8239;256&#8239;mg&#47;l&#41;&#44; piperacilin&#47;tazobactam &#40;MIC&#8239;&#62;&#8239;256&#8239;mg&#47;l&#41; and sensitivity to imipenem &#40;MIC&#8239;&#61;&#8239;1&#8239;mg&#47;l&#41;&#44; clindamycin &#40;MIC&#8239;&#61;&#8239;0&#46;5&#8239;mg&#47;l&#41; and metronidazole &#40;MIC&#8239;&#8804;&#8239;0&#46;016&#8239;mg&#47;l&#41;&#46; The CLSI criteria &#40;M100&#44; Ed&#46; 33&#41; were followed for the clinical interpretation of MIC&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The two cases were patients with severe enterocolitis who were admitted to hospital&#44; developing septic shock and dying within less than 24&#8239;h&#46; Antimicrobial treatment with piperacilin&#47;tazobactam&#44; very common in intra-abdominal infections&#44; would not be suitable for infections due to <span class="elsevierStyleItalic">Desulfovibrio</span> spp&#46;&#44; which is intrinsically resistant to it&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For the diagnosis of infections caused by <span class="elsevierStyleItalic">Desulfovibirio</span> spp&#46;&#44; it is important to remember the need to extract blood culture bottles in anaerobiosis&#44; in the case of enterocolitis&#44; incubate them for at least five days&#44; perform Gram staining on all blood culture bottles with growth detection&#44; leave the agar plates in incubation for 72&#8239;h in anaerobic atmosphere after having observed the microorganisms in the staining&#44; and perform the taxonomic assignment using molecular targets in the microorganisms not identified by usual methods &#40;for example&#44; biochemical tests&#44; mass spectrometry&#41;&#46; Added to that&#44; commercial multiplex PCR techniques would not identify these microorganisms either because they do not have them included in their targets&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D&#46; porci</span> is an anaerobic microorganism&#44; which is very slow and difficult to detect in blood cultures&#44; which could be involved in severe cases of infectious enterocolitis with sepsis&#46; The clinical implication of this microorganism could be underestimated if blood cultures are not processed correctly&#46; This is because it is slow to grow in liquid and solid media&#44; difficult to visualise in Gram stain and difficult to identify&#44; as it is not included in the databases of the commercial systems&#44; requiring the application of molecular targets with taxonomic value such as the <span class="elsevierStyleItalic">16S rRNA gene</span>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In general&#44; bacteraemia due to microorganisms of the genus <span class="elsevierStyleItalic">Desulfovibrio</span> is caused by the species <span class="elsevierStyleItalic">D&#46; desulfuricans</span> and <span class="elsevierStyleItalic">D&#46; fairfieldensis</span>&#44; due to bacterial translocation from the gastrointestinal tract in patients with colon disease&#44; with a good outcome in most cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In our cases&#44; <span class="elsevierStyleItalic">D&#46; porci</span> bacteraemia was associated with enterocolitis &#40;without being able to determine whether the <span class="elsevierStyleItalic">D&#46; porci</span> infection was the cause of the enterocolitis&#44; or the bacteraemia was a consequence of the intestinal disease&#41;&#44; severe sepsis and the death of the two patients due to septic shock&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">There was no funding for this study&#46;</p></span></span>"
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Original language: English
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